MR Imaging in Multiple Sclerosis: The Accuracy of 3D Double Inversion Recovery at 3 Tesla and the Potential for Single Sequence Imaging

Abstract

To compare the accuracy of a three dimensional, T2-weighted double inversion recovery (DIR) sequence with two dimensional fluid attenuated inversion recovery (FLAIR) and dual echo T2 (DE T2) sequences at 3 Tesla in the detection of intracranial demyelinating lesions in patients with known or suspected multiple sclerosis (MS), and to consider the appropriateness of a stand-alone DIR sequence in MS imaging. The studies of 98 patients who underwent imaging with DE T2, FLAIR and DIR sequences for known or suspected multiple sclerosis were retrospectively reviewed. In 42 cases, a diagnosis of MS had been clinically suspected. In the remaining 56 cases, a diagnosis of MS had been previously established. All patients were imaged on a 3T MRI unit. Coronal and sagittal FLAIR, axial DE T2, and three dimensional T2-weighted DIR sequences were utilised. Of the 42 patients with suspected multiple sclerosis, 11 demonstrated lesions characteristic of the disease. Demyelinating plaques were seen in all of the 56 patients with known MS. In all cases, all lesions seen on DE T2-or FLAIR sequences were visible and more conspicuous on the DIR sequence. In 22 of the 67 patients (33%) with demyelinating lesions, the DIR sequence showed additional lesions not visible on any of the other sequences. Additional detected lesions predominantly involved grey matter. At 3 Tesla, a T2 weighted, three dimensional DIR sequence is as accurate at detecting the presence of intracranial demyelinating lesions as two dimensional FLAIR and DE T2 sequences combined. A greater number of lesions were detected with the DIR sequence, and all lesions were more conspicuous. A single, stand alone DIR sequence may be considered appropriate for monitoring MS.

Magnetization transfer ratio in lesions rather than normal-appearing brain relates to disability in patients with multiple sclerosis

“…The use of the 3D DIR sequence for lesion segmentation could be considered a limitation of this study, since the DIR sequence is not the ''gold standard'' for white matter lesion detection and segmentation. However, several previous studies have shown that the detection rates of MS lesions on DIR are very similar to FLAIR and similar to or better than T2-weighted images in other brain compartments than the cortex, including the white matter and the deep gray matter [18,[40][41][42][43].…”

Lesion load assessment among multiple sclerosis patient using DIR, FLAIR, and T2WI sequences

“…Since there are no gaps between the slices, so 3D scans can easily keep the image quality in term of contrast-to-noise ratio (CNR) providing greater spatial resolution. Three-dimensional MRI sequences, due to the use of smaller slice thicknesses, detect smaller size MS plaques especially cortical lesions more precisely and less flow artifacts compared to two-dimensional sequences [34,36].…”

Pre- and Postcontrast 3D Double Inversion Recovery Sequence in Multiple Sclerosis: A Simple and Effective MR Imaging Protocol

“…In fact, because it was discussed in a previous study that a single DIR sequence may be considered appropriate for MS monitoring, 19 the approach presented in this study could contribute to a minimally time-consuming MR imaging protocol, including the acquisition of postgadolinium images, with only DIR pre-and postcontrast (approximately a 12-minute protocol). On the other hand, such short protocols could have limited sensitivity for treatment-associated complications such as progressive multifocal leukoencephalopathy; therefore, further studies are necessary to analyze the sensitivity of DIR regarding opportunistic diseases.…”